Foja, Nadhen Jane H.

BSRT III RT 316

ACTIVITY # 3 (Midterms)

1. What are the procedures used to diagnose breast cancer? Discuss how each
procedure can diagnose breast cancer.

Tests and procedures used to diagnose breast cancer include:

Breast ultrasound. A machine that uses sound waves to make pictures, called sonograms, of
areas inside the breast.

Diagnostic mammogram. If you have a problem in your breast, such as lumps, or if an area of
the breast looks abnormal on a screening mammogram, doctors may have you get a diagnostic
mammogram. This is a more detailed X-ray of the breast.

Breast magnetic resonance imaging (MRI). A kind of body scan that uses a magnet linked to a
computer. The MRI scan will make detailed pictures of areas inside the breast.

Biopsy. This is a test that removes tissue or fluid from the breast to be looked at under a
microscope and do more testing. There are different kinds of biopsies (for example, fine-needle
aspiration, core biopsy, or open biopsy).

2. What are the different biopsy procedures performed for diagnosing breast
cancer? Differentiate one from the other.

Types of breast biopsy procedures include:

Fine-needle aspiration biopsy. This is the simplest type of breast biopsy and may be used to
evaluate a lump that can be felt during a clinical breast exam. For the procedure, you lie on a
table. While steadying the lump with one hand, your doctor uses the other hand to direct a very
thin needle into the lump.
The needle is attached to a syringe that can collect a sample of cells or fluid from the lump.
Fine-needle aspiration is a quick way to distinguish between a fluid-filled cyst and a solid mass.
It may also help avoid a more invasive biopsy procedure. If, however, the mass is solid, you may
need a procedure to collect a tissue sample.

Core needle biopsy. This type of breast biopsy may be used to assess a breast lump that's
visible on a mammogram or ultrasound or that your doctor feels during a clinical breast exam. A
radiologist or surgeon uses a thin, hollow needle to remove tissue samples from the breast mass,
most often using ultrasound as a guide.
Several samples, each about the size of a grain of rice, are collected and analyzed. Depending
on the location of the mass, other imaging techniques, such as a mammogram or MRI, may be
used to guide the positioning of the needle to obtain the tissue sample.

Stereotactic biopsy. This type of biopsy uses mammograms to pinpoint the location of
suspicious areas within the breast. For this procedure, you generally lie facedown on a padded
biopsy table with one of your breasts positioned in a hole in the table. Or you may have the
procedure in a seated position. You may need to remain in this position for 30 minutes to 1 hour.
If you're lying facedown for the procedure, the table will be raised once you're in a comfortable
position. Your breast is firmly compressed between two plates while mammograms are taken to
show the radiologist the exact location of the area for biopsy.
The radiologist makes a small incision — about 1/4 inch long (about 6 millimeters) — into the
breast. He or she then inserts either a needle or a vacuum-powered probe and removes several
samples of tissue.

Ultrasound-guided core needle biopsy. This type of core needle biopsy involves ultrasound —
an imaging method that uses high-frequency sound waves to produce precise images of
structures within the body. During this procedure, you lie on your back or side on an ultrasound
table.
Holding the ultrasound device against the breast, the radiologist locates the mass, makes a
small incision to insert the needle, and takes several core samples of tissue.

MRI-guided core needle biopsy. This type of core needle biopsy is done under guidance of an
MRI — an imaging technique that captures multiple cross-sectional images of the breast and
combines them, using a computer, to generate detailed 3D pictures. During this procedure, you
lie facedown on a padded scanning table. Your breasts fit into a hollow depression in the table.
The MRI machine provides images that help determine the exact location for the biopsy. A small
incision about 1/4 inch long (about 6 millimeters) is made to allow the core needle to be inserted.
Several samples of tissue are taken.

Surgical biopsy. During a surgical biopsy, some or all of the breast mass is removed for
examination. A surgical biopsy is usually done in an operating room using sedation given
through a vein in the hand or arm and a local anesthetic to numb the breast.
If the breast mass can't be felt, the radiologist may use a technique called wire or seed
localization to map the route to the mass for the surgeon. This is done before surgery.
During wire localization, the tip of a thin wire is positioned within the breast mass or just through
it.
If seed localization is done, a small radioactive seed will be placed using a thin needle. The seed
will guide the surgeon to the area where the cancer is located. The seed is safe and gives off
only a very small amount of radiation.
During surgery, the surgeon will attempt to remove the entire breast mass along with the wire or
seed. To help ensure that the entire mass has been removed, the tissue is sent to the hospital lab
for evaluation. Pathologists working in the lab will work to confirm whether breast cancer is
present in the mass. They also evaluate the edges (margins) of the mass to determine whether
cancer cells are present in the margins (positive margins).
If cancer cells are present at the margins, you may need another surgery so that more tissue
can be removed. If the margins are clear (negative margins), then the cancer has been removed
adequately.

3. Contrast and compare benign from malignant breast mass or lesions.

BENIGN MALIGNANT

round of oval in form irregularly lobulated

well-defined ill-defined

softer and squishy hard

tend to move around stay put when you feel them

The nipple and skin may look different around

4. What does concordant mean in breast biopsy?

In medicine, a term that describes two or more findings that agree with one another when doing
a physical exam, imaging or lab test, or a biopsy. For example, feeling a suspicious breast lump
on a physical exam, having an abnormal mammogram, and finding breast cancer on a tissue
biopsy are considered concordant findings. Concordant findings help confirm a diagnosis.

A lesion which showed a suspicious finding for malignancy on images (i.e., Breast Imaging
Reporting and Data System [BI-RADS] category 4 or 5) and is diagnosed to be malignant on a
subsequent core needle biopsy is a concordant malignancy (Fig. 1). Within this category,
appropriate action should be taken without any delay. The radiologist should communicate the
biopsy result to the referring physician, and the patient should be informed of the results and
referred to a surgeon or oncologist for proper treatment.

(Fig.1 46-year-old woman with palpable mass in her right breast.)

Concordant: Is recommended after surgical excision of breast lesions to ensure that the lesion
of interest has been accurately targeted and adequately sampled. For image-detected
abnormalities, specimen imaging of fine-wire-guided excisions is recommended and all breast
surgical specimens should be oriented for the pathologist.

Disconcordant: Is results occur when benign pathology results do not account for imaging
findings. In cases of discordance, repeat biopsy or surgical excision should be performed to
avoid a delay in cancer diagnosis.

The imaging and pathologic findings are considered to be concordant when the pathologic
result provides an acceptable explanation for the imaging feature and discordant when they do
not.